Provider Demographics
NPI:1346307592
Name:SLAVENS, DAVID R (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:SLAVENS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16450 S TAMIAMI TRL
Mailing Address - Street 2:STE 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5307
Mailing Address - Country:US
Mailing Address - Phone:239-432-9909
Mailing Address - Fax:239-433-0289
Practice Address - Street 1:16450 S TAMIAMI TRL
Practice Address - Street 2:STE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5307
Practice Address - Country:US
Practice Address - Phone:239-432-9909
Practice Address - Fax:239-433-0289
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22034Medicare ID - Type UnspecifiedMEDICARE